During thyroid treatment when either the medication type or the dosage is being adjusted, it is really important to use a systematic process and to expect that there will be some difficulties along the way.
It is extremely important to have a lot of patience in order to do this well and to find the best solution that fixes your symptoms.
Finding the right type and amount of thyroid medication can take some time and it can involve many small steps towards finding a dosage that works. Sometimes a change is made that makes someone feel worse and this has to then be undone. This should be expected. It is rarely a matter of looking at laboratory test results and simply picking the right solution out of thin air.
Working out what the right thyroid treatment is and finding the right dosage is a process of exploration that often has speed bumps along the way. I provide protocols for determining the right dosage of Levothyroxine (T4), Liothyronine (T3), T4/ T3, and Natural Desiccated Thyroid (NDT) in The Thyroid Patient’s Manual book. I go into far more detail on T3 use for those that are on mostly T3, or T3-Only, in my Recovering with T3 book. The protocols involve working through a process of making medication changes and then measuring and observing the response of the body to the changes. This process may have to be repeated many times until real improvement occurs.
I recommend the use of symptoms and signs to track changes in medication and doses: https://paulrobinsonthyroid.com/tracking-thyroid-symptoms-and-signs-vitals/
Some thyroid patients who ask for support in finding the right choice of medication and doses are often very anxious and want to get some immediate improvement. Some of these have been looking for solutions for a long time and may have been given a lot of conflicting advice from different doctors, practitioners or other thyroid patients. In a few cases, the struggling thyroid patients may be on far too many medications including adrenal steroids, anti-depressants, and anti-anxiety drugs as well as thyroid medications. Often, some of these drugs were completely avoidable and are causing part of the problem and making it more difficult to adjust thyroid medication properly.
When a thyroid patient is very anxious it is very difficult for them to have the patience and systematic approach to changing thyroid medication and assessing the response to changes objectively. Sometimes the unfortunate thyroid patient wants to know before any change is made that it is going to work. Well, that simply is not possible to know. Working on finding the right solution for any individual is a process and takes time. It may involve several steps forward and then a step or two back. Even when someone has found an optimal dosage, this might not always be right for them. The body changes and may require a different thyroid dosage at a later time, in which case more effort would be required to assess this.
The process of improving thyroid medication dosage requires a cool head and the willingness to collect daily data on the response to thyroid medication. Importantly, in my view, basic signs like body temperature changes, blood pressure and heart rate changes are far more objective measures of real progress than just feelings. Some key symptoms like energy level, mental acuity and gut motility are also helpful and are easier to be objective about than other symptoms. This process is unlikely to be quick. So, a lot of patience is needed. In some cases, it is critical to assess signs and symptoms frequently during the day in order to work out how thyroid medication doses are affecting the patient. Frequent measurement can show that a thyroid dose is too high, too low, too soon or too late. See: https://paulrobinsonthyroid.com/tracking-thyroid-symptoms-and-signs-vitals/
I learned this myself the hard way when I was trying to recover from hypothyroidism well over twenty years ago. I began using T3 in multi-doses and thought I could manage this using my symptoms. I failed utterly and found myself confused on too many occasions. I gave up trying to do it this way and began tracking signs and symptoms rigorously every day. Frequently, the signs (vitals) told a completely different story to what my feelings were telling me. There were also times when I needed to retrace my steps to a set of doses of T3 that I was using a few weeks earlier and then try a different set of choices from that point onwards. T3-Only is harder to dose than other thyroid medications but the point still applies that being systematic and having patience is essential in all but the simplest of cases.
So, the worst combination I can think of is that of an anxious thyroid patient, who takes a cocktail of medications and supplements, and who is not being rigorous and systematic and lacks patience. In this situation, the person is likely to chop and change their plans far too often and will likely never find a good solution unless through pure luck. Luck tends not to happen that often in thyroid treatment by the way.
The other way to look at this is to realise that most thyroid patients with medication or dosing issues often took many years to get to this stage. It is unreasonable to expect a quick solution to come without a lot of hard work and diligence.
In my own case, even when I was on T3-Only it still took me three years to get onto the right dosage and a few more years beyond that to recover from ten years of severe ill-health. I only managed to do this by using signs and symptoms, which I collected every day, to guide me, and by being very patient. I am not a naturally patient man – quite the opposite actually. So, this was hard for me but I had realised that there was no other way that would work. There are no silver bullets when getting thyroid medication sorted. In my case, there were no books or any written work available that I could use to understand how to use the T3 thyroid hormone. My doctors also had no clue how to use it. I had to learn all of that as I went along. So I learned the hard way that being patient and systematic was the only way to do it. I put all the lessons I have learned over the years into the pages of all three of my books.
Sometimes it is also important to get off some of the other drugs that thyroid patients may have had suggested to them along the way. Obviously, taking a doctor’s advice about this is important.
There is a fable by Aesop, called “The Hare and the Tortoise”. The two animals have a race but the hare gets too excited and runs around too much and gets distracted and makes mistakes. The Tortoise just plods on slowly, and systematically, with his goal in mind. In this fable, the tortoise wins the race!
Finding the right dosage and type(s) of thyroid medication for a thyroid patient can be like this Fable. The thyroid patient who is slow, patient and organised usually finds a working dosage of thyroid medication even if it takes a while – just like the Tortoise. The thyroid patient who makes quick changes, or does not analyse enough information (not just thyroid labs), or is not patient and organised often gets very confused and goes around in circles without finding their solution – just like the Hare.
So, be prepared for a marathon and not a sprint. Use symptoms and signs as a key tool, as well as laboratory test results. Be calm. Anxiety and worry is not your friend. It gets in the way of the ability to collect the right data and then to assess it objectively. My books also provide a lot of sensible guidance on how to go about adjusting thyroid medication in a safe, organised and effective way.
Above all, be very patient, slow, careful and systematic, even if this means you remain symptomatic for a little longer than you would like to be. Have expectations that a lot of hard work will almost certainly be needed and that setbacks will inevitably happen on the way. It is better to get there with small, slow steps than not get there at all. Be the tortoise!
I hope some of you found this to be useful and that it helps you to get healthy!
Best wishes,
Paul
